Best Practice in Therapeutic Care for the Out-of-home Care Sector

It has been a pleasure to prepare this Special Issue of Children Australia. Inspired by Lighthouse Institute's ‘Journey to Recovery’ – the International Conference of Attachment and Trauma Informed Practice, which was held in Melbourne, 13–14 August 2013, this issue explores best practice in therapeutic care approaches in the out-of-home care sector. Lighthouse Institute is the trauma-informed knowledge centre of the Lighthouse Foundation, a not-for-profit organisation based in Melbourne, Victoria, which over the past 24 years has provided a home and programme of therapeutic care for children and young people with histories of complex trauma. Lighthouse Institute is proud to contribute to this special edition, which focuses on therapeutic care during a period of reform across Australia in out-of-home care, a time in which government and organisations are facing the challenge of moving from traditional models of care, to trauma-informed therapeutic models that focus on the developmental needs of children and young people with histories of abuse and neglect, and which are geared to promote trauma recovery. As an example, the Victorian state government's newly unveiled Out-of-home care – a five year plan (Department of Human Services, 2014), drawing on the Protecting Victoria's Vulnerable Children Inquiry, has taken important steps to address the need for a system-wide continuum of care that is therapeutic in focus and intent. Similar reforms are under way in South Australia, Queensland, New South Wales and other jurisdictions in response to a number of State and Federal inquiries into the treatment of children and young people in care. In Victoria, among key reforms, there has been a stated commitment to building a 100 per cent therapeutic care system and to trial new therapeutic care models. The Five year plan also focuses on reducing state residential care placements over the long term, through greater investment in therapeutic foster care and kinship care.

The goals of therapeutic care approaches are to specifically address the impacts of abuse and neglect on the physical, emotional and behavioural development of the child (Barton, Gonzalez, & Tomlinson, Reference Barton, Gonzalez and Tomlinson2012; McLean, Price-Robertson, & Robinson, Reference McLean, Price-Robertson and Robinson2011; Winnicott, Reference Winnicott, Winnicott, Shepherd and Davis1970). While diverse in terms of models and frameworks, therapeutic care programmes are broadly informed by a strong understanding of trauma and disrupted attachment, aiming to promote the positive development and wellbeing of children in out-of-home care.

Therapeutic approaches to out-of-home care have attracted increasing interest in Australia, as a specialised approach to meeting the care needs of children and young people in out-of-home care, from residential and group home settings, through to kinship and foster care. Children with histories of abuse and neglect need a healing, ‘secure base’ to enable positive development and wellbeing (Bloom, Reference Bloom2005; McLean et al., Reference McLean, Price-Robertson and Robinson2011). More than anything, this requires a care experience that is founded on consistency, nurture and long-term secure attachments with caregivers. Many traditional out-of-home care programmes, such as residential care, have struggled to address the complex needs of children with trauma histories (McLean et al., Reference McLean, Price-Robertson and Robinson2011). Research in Australia demonstrates that children in traditional residential care programmes have significantly poorer health and life outcomes, and are at risk of a range of behavioural, relational and psychological issues (Herman, Susser, & Struening, Reference Herman, Susser and Streuning1994; Mendes, Johnson, & Moslehuddin, Reference Mendes, Johnson and Moslehuddin2011; Osborn & Bromfield, Reference Osborn and Bromfield2007; Osborn & Delfabbro, Reference Osborn and Delfabbro2006). These children are further disadvantaged by a lack of consistent and appropriate care tailored to their specific needs. Institutional abuse and maltreatment in residential care have also contributed to poor outcomes (Parliament of Australia Senate, 2004).

We have been fortunate to have attracted nine high-quality research- and practitioner-focused papers in this Special Issue. Each paper gives expression to the promising new directions of therapeutic care in Australia and internationally, highlighting a range of out-of-home care contexts and programmes. Together, these contributions demonstrate how therapeutic care works to foster good outcomes for children, young people, carers, organisations, child protection systems and the broader community.

Dr Pauline McLoughlin

Research Fellow, Centre for Applied Social Research

RMIT University

Overview of Papers

We begin this issue with a critical review paper by Baidawi, Mendes and Snow, which looks at the transition from care and mental health outcomes for care leavers. This article sets the scene for this Special Issue, as it demonstrates what happens when inadequate care is provided to children and young people, and how this impacts on the psychological wellbeing of children and young people beyond care.

Moving into practice, in the paper by Bamblett, Long, Frederico and Salamone the experience of trauma by indigenous children is contextualised to provide an understanding of the deep roots of trauma at individual, familial and inter-generational levels. The holistic therapeutic model that was developed by the Victorian Aboriginal Child Care Agency (VACCA) to address the complex needs of Aboriginal children is explained, as well as its impact on children and young people.

The paper by Frederico, Long, McNamara and McPherson talks about what foster care should look like, with reference to the Victorian Circle Program. The importance of the stable relationship between carer and child is explored, and how this therapeutic relationship can facilitate healing of children who have experienced complex developmental trauma. This is followed Manley, Barr and McNamara, who provide a snapshot of early work undertaken by Baptcare Family and Community Services to develop a trauma-informed case management and therapeutic practice model in kinship and foster care. The paper focuses on the process of organisational change, highlighting the importance of integrating theory with practice in developing practitioners’ capacity to undertake their work in a therapeutic manner. In the paper written by kinship carers and professionals McPherson and MacNamara, kinship care, the most prevalent and fastest growing form of out-of-home care, is explored. It provides an examination of the needs of children in out-of-home care and the distinction between kinship and foster care, as well as demonstrating the therapeutic kinship-care model that was developed to address the needs of children in out-of-home care.

The following article, by Modi, Dyette, Nayar-Akhtar and Antra, takes the reader to India, to explore the great work being done with orphaned children by Udayan Care. The challenges involved in this complex work are explored, including the retention of staff and the measures that have been taken to ensure stability, which is critical in ensuring positive outcomes for the children in care. The systems approach is further explored by Smith and Toth, who look at the implementation of the Sanctuary Model™ by Christ Care Pathways, in the child protection sector in Queensland. It is argued that the Sanctuary approach can assist in healing trauma on an individual, organisational and community level, through demonstrating how this model has been used within residential and foster care.

The final two articles move us back into the area of leaving care. The article by Hussein and Cameron examines how the Lighthouse Therapeutic Family Model of Care supports young people in out-of-home care to transition successfully into interdependent living in the community. The article highlights the four-stage process of recovery for young people with complex trauma histories, and how this programme supports young people to transition from care. Mendes, Michell and Wilson then round off the special issue with a paper that highlights the poor educational outcomes for young people who transition from care. This sobering paper, based on current international research, raises questions about the way children and young people are being supported to achieve academic success in out-of-home care and post care. Some proposed practice and policy reforms are discussed, which can contribute to improving outcomes for this population in the future.

This Special Issue has shone a light on the challenges of providing therapeutic care for children and young people in out-of-home care, as well as some of the innovative research and practice in this field, which is leading to better outcomes. The move towards therapeutic care in Australia is gaining momentum, with many organisations now moving towards trauma-informed practice. This issue shows some of the pioneering work that is being done in Australia and internationally. I would like to thank the authors for their papers, which have contributed to this exciting issue of Children Australia. I hope that the readers get as much from reading these papers as we have, and that the knowledge that we are gaining from therapeutic-care practice leads to practice and policy improvements and to better outcomes for children and young people in out-of-home care.

Rudy Gonzalez

Executive Director, Lighthouse Institute